Publications by authors named "Kerstin Spanhel"

7 Publications

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Cultural adaptation of internet- and mobile-based interventions for mental disorders: a systematic review.

NPJ Digit Med 2021 Aug 25;4(1):128. Epub 2021 Aug 25.

Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany.

Providing accessible and effective healthcare solutions for people living in low- and middle-income countries, migrants, and indigenous people is central to reduce the global mental health treatment gap. Internet- and mobile-based interventions (IMI) are considered scalable psychological interventions to reduce the burden of mental disorders and are culturally adapted for implementation in these target groups. In October 2020, the databases PsycInfo, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were systematically searched for studies that culturally adapted IMI for mental disorders. Among 9438 screened records, we identified 55 eligible articles. We extracted 17 content, methodological, and procedural components of culturally adapting IMI, aiming to consider specific situations and perspectives of the target populations. Adherence and effectiveness of the adapted IMI seemed similar to the original IMI; yet, no included study conducted a direct comparison. The presented taxonomy of cultural adaptation of IMI for mental disorders provides a basis for future studies investigating the relevance and necessity of their cultural adaptation.PROSPERO registration number: CRD42019142320.
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http://dx.doi.org/10.1038/s41746-021-00498-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8387403PMC
August 2021

Protocol for a systematic review and meta-analysis of culturally adapted internet- and mobile-based health promotion interventions.

BMJ Open 2020 11 9;10(11):e037698. Epub 2020 Nov 9.

Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany.

Introduction: High rates of immigration pose challenges for the healthcare systems of many countries to offer high-quality care to diverse populations. Advancing health interventions with incorporating the cultural background of diverse populations can be helpful to overcome this challenge. First studies suggest that culturally diverse populations might benefit from culturally adapted internet-based and mobile-based interventions (IMI) to promote health behaviours. However, the effectiveness of culturally adapted IMIs for health promotion interventions has not been evaluated systematically. Therefore, the aim of this review is to assess the effectiveness of culturally adapted IMIs regarding health promotion. Additionally, the cultural adaptation features of these interventions will be outlined.

Methods And Analysis: Randomised controlled trials (RCTs) investigating the effectiveness of culturally adapted IMIs to promote health behaviours in the field of healthy eating, smoking cessation, alcohol consumption, physical activity and sexual health behaviour will be identified via a systematic search of the databases MEDLINE, Embase, PsycINFO, CENTRAL. The preliminary search has been conducted on the 26 August 2019 and will be updated in the process. Data will be pooled meta-analytically in case of at least three included studies reporting on the same outcome. Moreover, a narrative synthesis of the included studies will be conducted. The risk of bias will be assessed using the Cochrane Collaboration's tool for the Quality Assessment of RCTs V. 2.0. Publication bias will be assessed using funnel plots.

Ethics And Dissemination: Ethical approval is not required for this study. The results of this study will be published in a peer-reviewed international journal.

Prospero Registration Number: PROSPERO; CRD42020152939.
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http://dx.doi.org/10.1136/bmjopen-2020-037698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7654131PMC
November 2020

Cultural adaptation of Internet- and mobile-based interventions for mental disorders: a systematic review protocol.

Syst Rev 2020 09 3;9(1):207. Epub 2020 Sep 3.

Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, 79085, Freiburg, Germany.

Background: Internet- and mobile-based interventions (IMI) are an effective and scalable low-threshold solution to reach people who are undersupplied by current healthcare. Adapting interventions to the cultural and ethnic background of the target group enhances their acceptance and effectiveness. However, no systematic approach to cultural adaptation of IMI has been established so far. Therefore, this review aims to summarise components and procedures commonly used in the cultural adaptation of IMI for mental disorders, as well as the current evidence base on whether such a cultural adaptation leads to an increased acceptance, adherence, and effectiveness of IMI for mental disorders.

Methods: A systematic literature search will be performed using the following databases: MEDLINE, Embase, PsycINFO, CENTRAL, and WoS. The search term will include keywords related to cultural adaptation, IMI, and mental disorders/disturbances. Two independent reviewers will evaluate studies against inclusion and exclusion criteria and extract study and intervention characteristics, details on the cultural adaptation approach, and outcome data. Quality of evidence will be assessed using the Quality Assessment Tool for Reviewing Studies with Diverse Designs, and results will be synthesised qualitatively.

Discussion: Providing adequate mental healthcare regardless of cultural backgrounds is a major global health challenge. The planned systematic review will lay the foundation for the further development of the cultural adaptation of IMI for mental disorders by summarising the current state and providing recommendations for future research.

Systematic Review Registration: PROSPERO CRD42019142320.
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http://dx.doi.org/10.1186/s13643-020-01438-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7472576PMC
September 2020

Effectiveness of a Guided Web-Based Self-help Intervention to Prevent Depression in Patients With Persistent Back Pain: The PROD-BP Randomized Clinical Trial.

JAMA Psychiatry 2020 10;77(10):1001-1011

Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany.

Importance: Depression is a frequent comorbid condition in patients with persistent back pain and is associated with substantial adverse consequences, including the risk of developing opioid use disorders. Shifting the focus from depression treatment to preventing depression might be a viable way to reduce the disease burden.

Objective: To evaluate the effectiveness of a web-based self-help intervention to reduce the incidence of major depressive episode (MDE) in patients with persistent back pain.

Design, Setting, And Participants: Prevention of Depression in Back Pain Patients (PROD-BP) was a pragmatic, observer-blinded randomized clinical trial with a parallel design conducted in Germany. Eligible adults with a diagnosis of persistent back pain and subclinical depressive symptoms, but who were depression free, were recruited either on-site or after discharge from 82 orthopedic clinics between October 1, 2015, and July 31, 2017. All analyses were conducted according to the intention-to-treat principle from October 31, 2018, to April 30, 2019.

Interventions: The intervention group received an e-coach-guided, web-based self-help intervention that was based on cognitive behavioral therapy and tailored to the needs of patients with persistent back pain. The intervention included 6 obligatory modules and 3 optional modules to be completed by participants as well as feedback from e-coaches. Both the intervention and control groups had unrestricted access to treatment as usual.

Main Outcomes And Measures: Primary outcome was time to onset of an MDE over a 12-month period as assessed by blinded diagnostic raters using the Structured Clinical Interview for DSM-5. Secondary outcomes included depression severity, quality of life, pain intensity, pain-related disability, pain self-efficacy, work capacity, and user satisfaction assessed with a variety of instruments.

Results: A total of 295 participants (mean [SD] age, 52.8 [7.7] years; 184 women [62.4%]) were recruited and randomized to either the intervention group (n = 149) or control group (n = 146). The intervention reduced the risk of MDE onset by 52% (hazard ratio, 0.48; 95% CI, 0.28-0.81; P < .001). Twenty-one participants (14.1%) in the intervention group and 41 participants (28.1%) in the control group experienced an MDE over the 12-month period. The number needed to treat to prevent 1 new case of MDE was 2.84 (95% CI, 1.79-9.44).

Conclusions And Relevance: Results of this trial showed that among patients with persistent back pain, depression can be prevented by a guided web-based self-help intervention in addition to treatment as usual. This finding suggests that using a scalable digital approach to integrate psychological treatment into routine pain management is feasible.

Trial Registration: German Clinical Trials Register Identifier: DRKS00007960.
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http://dx.doi.org/10.1001/jamapsychiatry.2020.1021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254449PMC
October 2020

'Help for trauma from the app stores?' A systematic review and standardised rating of apps for Post-Traumatic Stress Disorder (PTSD).

Eur J Psychotraumatol 2020 9;11(1):1701788. Epub 2020 Jan 9.

Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany.

: Mobile health applications (apps) are considered to complement traditional psychological treatments for Post-Traumatic Stress Disorder (PTSD). However, the use for clinical practice and quality of available apps is unknown. : To assess the general characteristics, therapeutic background, content, and quality of apps for PTSD and to examine their concordance with established PTSD treatment and self-help methods. : A web crawler systematically searched for apps targeting PTSD in the British Google Play and Apple iTunes stores. Two independent researchers rated the apps using the Mobile App Rating Scale (MARS). The content of high-quality apps was checked for concordance with psychological treatment and self-help methods extracted from current literature on PTSD treatment. : Out of 555 identified apps, 69 met the inclusion criteria. The overall app quality based on the MARS was medium (M = 3.36, SD = 0.65). Most apps (50.7%) were based on cognitive behavioural therapy and offered a wide range of content, including established psychological PTSD treatment methods such as processing of trauma-related emotions and beliefs, relaxation exercises, and psychoeducation. Notably, data protection and privacy standards were poor in most apps and only one app (1.4%) was scientifically evaluated in a randomized controlled trial. : High-quality apps based on established psychological treatment techniques for PTSD are available in commercial app stores. However, users are confronted with great difficulties in identifying useful high-quality apps and most apps lack an evidence-base. Commercial distribution channels do not exploit the potential of apps to complement the psychological treatment of PTSD.
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http://dx.doi.org/10.1080/20008198.2019.1701788DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6968629PMC
January 2020

Cultural adaptation of internet interventions for refugees: Results from a user experience study in Germany.

Internet Interv 2019 Dec 21;18:100252. Epub 2019 May 21.

Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, D-79085 Freiburg, Germany.

Background: The estimated number of refugees worldwide resulting from persecution, conflict, violence, or human rights violations reached 25.4 million in 2017. An increased prevalence of mental disorders combined with language and socio-cultural barriers pose a challenge for healthcare systems. Internet-based interventions can help to meet this challenge. For the effective use of such interventions in refugees, cultural adaptations are necessary. The variety of their cultural backgrounds thereby is particularly challenging.

Methods: We conducted this explorative qualitative study in order to identify elements of Internet-based interventions that need cultural adaptation to be suitable for refugees. Six refugees from Syria, Iran, Eritrea, Algeria, and Iraq, and six healthcare providers (two social workers, two psychologists, one physiotherapist, one physician) working with refugees went through an intervention for individuals with sleeping problems (). Possible threats to user experience were identified using the Think Aloud method and semi-structured interviews. Statements were analysed based on the grounded theory method.

Results: Results indicate the necessity to adapt the intervention to the specifics of refugees including aspects related to the flight (i.e., past and current stressors) and non-western characteristics (i.e., habits, disease and treatment concepts). Elements of adaptation should include pictures, role models, language, psychoeducational elements, structure of modules, and format of presentation.

Conclusions: Cultural adaptation can be used to facilitate the identification with an intervention, which seems crucial to increase the acceptance among refugees. In spite of their diverse cultural backgrounds, it appears feasible to create interventions that allow identification by refugees from different home countries.
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http://dx.doi.org/10.1016/j.invent.2019.100252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6926246PMC
December 2019

Flashbulb memories: Is the amygdala central? An investigation of patients with amygdalar damage.

Neuropsychologia 2018 03 6;111:163-171. Epub 2018 Jan 6.

Department of Neurosurgery, Epilepsy Center, Medical Center - University of Freiburg, Germany.

Flashbulb memories (FM) are a subgroup of autobiographical memories referring to the circumstances in which a person first heard of a surprising, emotionally arousing event. Patients with temporal lobe epilepsy (TLE) have been reported to be impaired in FM recall. As emotional arousal is central to FM, various authors have suggested a crucial role of the amygdala. However, to date, no studies have directly addressed this hypothesis. In this study, 33 TLE patients and 20 healthy controls (HC) were tested on an FM task twice with a minimum interval of two months. FM recall quality was measured as consistency of the answers. Patients were grouped according to the presence as well as the lateralisation of amygdalar damage, using information of brain imaging and intracranial electroencephalography-recordings. Analyses revealed that, relative to HC, patients with amygdalar damage had significantly diminished FM recall quality, whereas patients with intact amygdalae did not. Particularly patients with amygdalar damage in the non-language-dominant hemisphere performed significantly worse than HC. Findings suggest a negative influence of amygdalar damage, possibly especially in the non-dominant hemisphere, on FM retrieval quality. Given the shocking character of events evoking FM, a rapid emotion detection system involving the right (i.e. non-dominant) amygdala could be influential to FM formation. Thus, the present findings support previous, not yet examined, hypotheses concerning a crucial role of the amygdala in FM.
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http://dx.doi.org/10.1016/j.neuropsychologia.2018.01.004DOI Listing
March 2018
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